Use of Hemostatic Clips in Patients Undergoing Colonoscopy in the Setting of Coumadin Anticoagulation Therapy

Howell, Douglas A.; Eswaran, Sheila; Loew, Burr J.; Sanders, Michael K.; Erkkinen, John F.; Bernadino, Kirk P.; Potter, Bejamin B.; Millspaugh, Gordon A.; Morse, James H.; Roy, Michael A.; Stefan, Andreas; Sze, Karl C.; Campana, Janice M.

doi:10.1016/j.gie.2006.03.092

Cited by 8 publications

(4 citation statements)

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“…31 Case series of prophylactic clip application after polypectomy of small polyps (!1 cm) in patients taking antithrombotic agents demonstrate low rates of bleeding (0%-3.3%). [32][33][34][35] However, no randomized controlled trials in patients actively using antithrombotic agents have been performed. Because of the lack of definitive clinical data and associated costs, routine application of prophylactic mechanical clips or detachable snares in these patients cannot be recommended at this time.…”

Section: Elective Endoscopic Procedures In Patients Receiving Antithrmentioning

confidence: 99%

Management of antithrombotic agents for endoscopic procedures

Anderson¹,

Ben–Menachem²,

Gan³

et al. 2009

Gastrointestinal Endoscopy

477

299

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Section: Elective Endoscopic Procedures In Patients Receiving Antithrmentioning

confidence: 99%

Management of antithrombotic agents for endoscopic procedures

Anderson¹,

Ben–Menachem²,

Gan³

et al. 2009

Gastrointestinal Endoscopy

477

299

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“…15–19 The reduction in bleeding risk also appears to be present in patients on anti-platelet or anti-coagulation therapy at the time of polypectomy. 20 In addition, clips are widely used with one study showing that more than 20% of endoscopists routinely use endoscopic clips in an attempt to decrease post-polypectomy bleeding. 21 However, societal guidelines do not make any firm recommendations on routine placement of endoscopic clips after polypectomy.…”

Section: Introductionmentioning

confidence: 99%

A Cost-efficacy Decision Analysis of Prophylactic Clip Placement After Endoscopic Removal of Large Polyps

Parikh¹,

Zanocco

Keswani³

et al. 2013

Clinical Gastroenterology and Hepatology

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Background and Aims Delayed bleeding after lower endoscopy and polypectomy can cause significant morbidity. One strategy to reduce bleeding is to place an endoscopic clip on the polypectomy site. We used decision analysis to investigate the cost effectiveness of routine clip placement after colon polypectomy. Methods Probabilities and plausible ranges were obtained from the literature, and a decision analysis was conducted using TreeAge Pro 2011 (TreeAge Software, Williamstown, MA). Our cost-effectiveness threshold was an incremental cost effectiveness ratio of $100,000 per quality adjusted life year. The reference case was a 50 year old patient who had a single 1.0–1.5 cm polyp removed during colonoscopy. We estimated post-polypectomy bleeding rates for patients receiving no medications, those with planned resumption of anti-platelet therapy (nonaspirin), or those receiving anticoagulation therapy after polypectomy. We performed several sensitivity analyses, varying the cost of a clip and hospitalization, number of clips placed, clip effectiveness in reducing post-polypectomy bleeding, reduction in patient utility days related to gastrointestinal bleeding, and probability of harm from clip placement. Results Based on the reference case, when patients did not receive anti-coagulation therapy, clip placement was not cost effective. However for patients who did receive anticoagulation and anti-platelet therapies, prophylactic clip placement was a cost-effective strategy. The cost-effectiveness of a prophylactic clip strategy was sensitive to the costs of clips and hospitalization, number of clips placed, and clip effectiveness. Conclusions Placement of a prophylactic endoscopic clip after polypectomy appears to be a cost-effective strategy for patients who receive anti-platelet or anticoagulation therapy. This approach should be studied in a controlled trial.

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“…As stated above, it is clear that endoscopic clips are an acceptable option for ulcer bleeding (3) and are likely an effective option for vascular lesions such as Dieulafoy's lesions and Mallory-Weiss tears (4,5). Endoscopic clips may be useful to prophylactically close mucosal defects after endoscopic mucosal resection (25) or high-risk polypectomy cases (such as those that require restarting antiplatelet or anticoagulant therapy) (9,26). Securing stents (27) and feeding tubes (28,29) have also been described, but effectiveness at preventing migration beyond a short time is not clear.…”

Section: Indicationsmentioning

confidence: 99%

Endoscopic Clips: Past, Present and Future

Romagnuolo

2009

Canadian Journal of Gastroenterology

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A form of the metal clip (also known as a 'hemoclip' or 'endoclip') for flexible endoscopes has now been available for more than 15 years (1), with early versions presented more than 30 years ago (2). Although uptake was initially slow, clips have made their way into standard gastrointestinal endoscopic practice for common indications, such as ulcer (3), Mallory-Weiss tear (4,5), diverticular bleeding (6,7), or bleeding or high-risk (8-10) polypectomy sites. They are also increasingly being used for uncommon indications, such as securing stents (11,12), feeding tubes (13) and other devices; marking of endoscopic lesions for x-ray or magnets (14,15); closing fistulas as presented in the article by Hameed et al (16) in this month's Journal (pages 217-219); and perforations (17), including sealing the luminal entry site in experimental natural orifice transluminal endoscopic surgery (NOTES) (18). The indication with the highest level of evidence at the present time is clearly ulcer hemostasis (3), but animal models and case series of other indications are rapidly accumulating.

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Use of Hemostatic Clips in Patients Undergoing Colonoscopy in the Setting of Coumadin Anticoagulation Therapy

Cited by 8 publications

References 0 publications

Management of antithrombotic agents for endoscopic procedures

Management of antithrombotic agents for endoscopic procedures

A Cost-efficacy Decision Analysis of Prophylactic Clip Placement After Endoscopic Removal of Large Polyps

Endoscopic Clips: Past, Present and Future

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